| NPI | 1760922397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209015694) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: IL 209-015694) |
| Enumeration Date | 2017-03-01 |
| Last Update Date | 2022-09-19 |